The association of findings on brain computed tomography with neurologic outcomes in patients with poor-grade subarachnoid hemorrhage

Objective: We evaluated if the optic nerve sheath diameter (ONSD) and computed tomography (CT) grading scale on brain CT could be used to predict neurological outcomes of patients with poor-grade subarachnoid hemorrhage (SAH). Methods: This was a retrospective, multicenter, observational study of adult patients with poor-grade SAH admitted January 2012 through June 2017. Initial brain CT was performed within 12 h from the onset of SAH, and follow-up brain CT was performed within 24 h from the treatment of ruptured aneurysm. The primary outcome was neurological status at six-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5). Results: Among 96 patients with poor-grade SAH, survival to discharge was identified in 78 (81.3%) patients. Of these 78 survivors, 63 (65.6%) had good neurological outcomes (GOS of 3, 4 or 5). In this study, initial ONSDs and follow-up ONSDs in the poor neurological outcome group were significantly greater than those in the good neurological outcome group (all p ≤ 0.003). A linear correlation existed between the average ONSD and ICP in simple correlation analysis (ρ = 0.719, P = 0.001). The ROC curve analysis for prediction of poor neurological outcome showed that ONSD had considerable predictive value (C-statistics: 0.684 to 0.798). In addition, the performance of a composite of Fisher grade and ONSD was increasingly associated with poor neurological outcomes than the use of either marker alone. Multivariable logistic regression analysis revealed that age (adjusted odd ratio [OR] 1.04, 95% confidence interval [CI] 1.001 – 1.071), Fisher grade (adjusted OR 16.10, 95% CI 2.965 – 87.483) and follow-up ONSD (adjusted OR 15.25, 95% CI 3.522 – 66.061) were significantly associated with poor neurological outcomes of SAH patients. Conclusions: The ONSDs and Fisher CT grading scale measured on CT scanning may be used to predict neurological outcomes of patients with poor-grade SAH.

研究目的：本研究旨在评估视神经鞘直径（optic nerve sheath diameter, ONSD）及颅脑计算机断层扫描（computed tomography, CT）分级量表，能否用于预测分级不良蛛网膜下腔出血（subarachnoid hemorrhage, SAH）患者的神经功能预后。
研究方法：本研究为一项回顾性多中心观察性研究，纳入2012年1月至2017年6月收治的成年分级不良SAH患者。所有患者均于SAH发病后12小时内完成首次颅脑CT检查，并于破裂动脉瘤治疗后24小时内完成随访颅脑CT。本研究的主要结局指标为采用格拉斯哥预后量表（Glasgow Outcome Scale, GOS，1~5分）评估的6个月随访神经功能状态。
研究结果：本研究共纳入96例分级不良SAH患者，其中78例（81.3%）患者存活至出院。在这78例存活患者中，63例（65.6%）获得良好神经功能预后（GOS评分3、4或5分）。本研究中，神经功能预后不良组的首次及随访视神经鞘直径均显著高于预后良好组（所有P值≤0.003）。简单相关分析显示，平均视神经鞘直径与颅内压（intracranial pressure, ICP）呈线性相关（ρ=0.719，P=0.001）。针对神经功能预后不良预测的受试者工作特征（Receiver Operating Characteristic, ROC）曲线分析显示，视神经鞘直径具有较好的预测价值（C统计量：0.684~0.798）。此外，联合采用Fisher分级与视神经鞘直径进行预测时，相较于单独使用任一指标，其与神经功能预后不良的相关性显著提升。多变量logistic回归分析显示，年龄（校正比值比[OR]1.04，95%置信区间[CI]1.001~1.071）、Fisher分级（校正OR 16.10，95%CI 2.965~87.483）及随访视神经鞘直径（校正OR 15.25，95%CI 3.522~66.061）均与SAH患者的神经功能预后不良显著相关。
研究结论：通过CT扫描测得的视神经鞘直径与Fisher CT分级量表，可用于预测分级不良SAH患者的神经功能预后。